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General NPI Number Information
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NPI Number | 1093337784
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Entity Type | Organization
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Legal Business Name | BRIGHT SOURCE HOSPICE LLC
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 09/15/2024
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Provider Practice Location Address
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Address Line | 226 S BEVERLY DR STE 217
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3844
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Country | US
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Telephone | 310-383-7760
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Fax | 310-405-0808
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Provider Business Mailing Address
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Address Line | 226 S BEVERLY DR STE 217
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3844
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Country | US
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Telephone | 310-383-7760
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Fax | 310-405-0808
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Authorized Official
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Title or Position | CEO
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Name | QUERUBIN IGNACIO
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Credential |
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Telephone | 310-383-7760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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